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FOR OFFICE USE: --------------------------------------------------------- --------------------------------- -------- ---- ------ APPLICATION FOR SANITATION PERMIT Permit No. _...�.�_�_i... .... ---------------------------------- ------------------ --- (Complete in Duplicate) Date Issued ---f.�-:-1.1.-_�3 -_............. ...... . ............_._-.__--___.___ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND 11LOCATION----r21-4-0.2.r--------- --------- ---•--W---6 V------------------------------- ------ ----------- Owner's Name--- 1 1--i°tit-----------1 a+ _- ---------------••----••------------------- -------------------------------------------- PhoneG __1-246.0..... Address---_--------------------&US-7---------- -------- ----------------------------------- Contractor's - Name----------'�1'"fi21 A5-t�.......j N--�--------------------------------------------------------------------------- �co ---- Phona.h ..q--(Q--a?-- Installation will serve: Residence ❑ Apartment House ❑ Commercial x Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths ---t--- Lot size .... ---->(-----90-0-__--__________________ Water Supply: Public system F Community system ❑ Private ❑ Depth to Water Table .<W- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe% Hardpan ❑ Previous Application Made: (If yes,date-----------:--------) No ® New Construction: Yes X No ❑ FHA/VA: Yes ❑ No�' TYPE OF INSTALLATION AND SPECIFICATIONS: / (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well- QDistance from foundation----- _Q_---------MatiaL_�-�yE��_------------- No, of compartments_______ _______.__Size___3x.�__ _ _.___Liquid depth_ I--_---------Capacity__-Q 0 Disposal Field: Distance from nearest well.---57.0-.--_Distance from foundation------IC-------Distance to nearest lot line-----b ------- N -.__Length of each line-------------a_Q_'_.__.Width of trench.-------- -- -�'_----------•-- Number of lines______________ ______ .L Type of filter material____ 1�_1�.____Depth of filter material----------LE"�---Total length-------------------------y— -._--- Seepage Pit: Distance to nearest well---------------------- from foundation-------------------Distance to nearest lot line--.-_.-___----_-_ �. ❑ Number of pits----------------------Lining material---------- Diameter.---------------------.Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----.--------------------------------- - ❑ Size: Diameter--------------------------------------Depth----------------------------------- ---------------Liquid Capacity----------------------------9_fsr�� Privy: Distance from nearest welt-------------------------------------------------Distance from nearest building-----.--_._._--_-.-_-----•---------_-.-. ❑ Distance to nearest lot line-------------------------- -- ----------------- -------------------------------------- --------------------------------- ------------------ Remodeling and/or repairing (describe):-------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 1�'k. a= ____ 1 1r ----------------------------------------------•------------------------------------------- ------------------------------------------------------------------------------------------.-----.--------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and } regulations of the San Joaquin Local Health District. (Signed)---------- /---�----- - - - ------ - -------- ----------------------------------•-------------------------------(O ner and/or Contractor] 4- By: # Lf ---------- -- ------------------------------------------------------------(Title)Y ( )---------- --------- ---- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_.._,4 --- '' DATE----Z----�L-----f1-/..... ---------- REVIEWEDBY------------------------- ------------------------- DATE------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------- ------------------------------—-------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendations:__.; .. ----._-.� -------- ------ - --- ` `'P :zit e ------------- ------------- ��._ -r:- .-A------------------------------------------------------------------------------------------------- ------------------- ------------------------------ FINAL INSPECTION BY:---/4-t/,.:-- - ----- '`L�___.____._..-- Date--.----I-�, �-E�---- w SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 724 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.CG. _j